Running head It’s No Joke: The State of the World’s Toilets 2015 WaterAid/Poulomi Basu Hanging latrines surrounded by rubbish in Madagascar. WaterAid/Anna Kari Introduction We all laugh at toilet humour – but the state This is a problem that can be solved. of the world’s toilets is really no joke. In September, the UN adopted new Global For people in developed countries, flushing Goals on sustainable development. The entire a toilet and turning on a tap is taken for world has come together to agree a path to a granted. But more than 650 million people in fairer, more sustainable world – one in which the world do not have access to clean water, extreme poverty is eliminated and no matter and more than 2.3 billion do not have access where you are you have enough to eat, clean to a safe, private toilet.1 Diarrhoea is one water to drink, a safe, private place to relieve of the three most common killers of young yourself and soap and water to wash with. children globally, along with pneumonia and malaria.2 Most of these deaths – 58% of Goal 6 promises adequate, equitable access them – could be prevented by clean water, to water, sanitation and hygiene to everyone sanitation and good hygiene including everywhere by 2030. handwashing with soap.3 Now we need to work together to bring these That is more than 314,000 young children4 goals to fruition. who could be saved, every year. This report shows us where we need to start. 1 It’s No Joke: The State of the World’s Toilets 2015 The background: why your toilet is so important Your toilet. You use it every morning without and hygiene are not in place, can be illustrated by thought, and the idea of trying to get by without an ‘F’ diagram: minute particles of faeces, which one is almost impossible to imagine. But doing get onto fingers, are spread by flies, picked up in without a toilet has many terrible, tragic costs fields, spread through fluids (including waterways) for communities. and then ingested, either directly or when a person eats contaminated food (see diagram below).6 In Not having a proper toilet, whether you defecate in addition, flies carrying faeces can land on faces, the open or use a bucket or rudimentary pit latrine spreading infections or blinding eye disease. which leaks its contents, means you have no way to prevent your faeces from contaminating your Contamination routes include water polluted by pit environment. This is a one-way street to illness – latrines or open defecation, food prepared in the one gram of faeces carries up to 1 million bacteria presence of faecal matter, poor or no handwashing and 10 million viruses.5 When faeces is let loose in after using the toilet or changing nappies, and poor your environment, minute amounts contaminate or no cleaning of anything that has been in contact your hands, food and water, and spread diseases. with faeces. This faecal-oral transmission of disease, which This transmission has a far wider impact than many happens when the barriers of toilets, safe water people realise. Fluids Fields Faeces Foods New host Flies Fingers Source: UN Water http://esa.un.org/iys/docs/IYS%20Advocacy%20kit%20ENGLISH/Fact%20sheet%201.pdf 2 The background: why your toilet is so important Source: World Health Organization/UNICEF • Maternal health After the first week of life, sepsis is the most common cause of death of babies up to one Every day, 800 women around the world die of month old. preventable causes associated with pregnancy and childbirth.7 Of these deaths, 99% are in developing countries, and more than 10% are • Child health caused by sepsis, a condition which arises when Children younger than five years are more the body cannot cope with severe infection. susceptible to infections when growing up in a place with dirty water and poor sanitation In South Asia, nearly 14% of maternal deaths than are older children, and the impacts follow can be attributed to sepsis.8 Many of these them well beyond early childhood. If children deaths are preventable. If women can give birth live in a community without toilets, the areas in in clean, hygienic surroundings, and their which they play and live are contaminated by babies are delivered by skilled attendants who human waste. This is very easily spread to their have been able to wash their hands with soap hands and food, and into their bodies. and sterilise their instruments, the likelihood of infection is greatly reduced. Yet results of a Preventable diarrhoeal illnesses linked to World Health Organization (WHO) survey of low- dirty water and poor sanitation kill more than income and middle-income countries showed 314,000 children under five every year.11 that 38% of health-care facilities do not have Many hundreds of thousands more are left even basic access to water, 19% do not have stunted, their physical, cognitive and social basic sanitation and 35% do not have water and development impaired by malnutrition (by which soap for handwashing.9 in this report we mean undernutrition – the under-absorption of nutrients). • Newborn mortality The first few weeks of a baby’s life are when they Malnutrition doesn’t just occur when there isn’t are most vulnerable, especially when they are in enough food – repeated infections and diarrhoea an environment with dirty water, poor sanitation make it difficult for a child’s small body to and inadequate hygiene. The environment in absorb nutrients. which babies are born has an important impact on whether the bacteria that cause sepsis are Studies show that stunting is more common in spread, before, during and after delivery. places with high rates of open defecation, because faecal matter contaminates the food, In Sub-Saharan Africa and South Asia in 2013, water and general environment, making sepsis, meningitis and tetanus – all infections children frequently ill, and can permanently that are linked to unhygienic environments – damage children’s intestines and thereby their killed more than 400,000 newborn babies.10 ability to absorb nutrients. 3 It’s No Joke: The State of the World’s Toilets 2015 The implications reach for their students.12 beyond health. The impact of inadequate toilets at school is greater on girls who have begun menstruation. Without proper sanitary supplies or a safe, • Gender equality private place at school to wash and care for It is women and girls who feel the impact of a themselves, many girls stay home for that week lack of sanitation most severely. Without a safe, each month; they quickly fall behind, and it’s private place to relieve themselves, girls and often not long before they stop attending entirely. women are often left with no choice but to go out at daybreak or in the evening to find a place • Economic development to go in a field, roadway, railway track or bush. The cost of hospital beds full of people suffering These unhygienic, unsafe conditions can from preventable illnesses linked to dirty water contribute to infection and leave them more and poor sanitation holds back a country’s vulnerable to harassment or assault. workforce and its economic development. The annual global economic losses associated How girls and women care for themselves during with inadequate water supply and sanitation their periods is also of major concern – not just are estimated to be US$260 billion.13 for the risk of infection but for the lack of dignity a woman experiences when she does not have This is nearly double the net overseas a safe, private place to manage her periods. development aid – $135.2 billion – given by donor nations in 2014.14 • Education Imagine if your primary school had no toilets in Keeping communities healthy increases working condition, or if there were just one or productivity and opportunity. Investing in water two in a school of 600 or more students. This is and sanitation systems has tremendous the reality for too many primary schools in economic rewards – at least $6 return on every developing countries, and it has a serious $1 spent on eliminating open defecation, and impact on how long students are able to stay in $3 for every $1 spent on sanitation.15 education. Children who are frequently off sick because of infections picked up in unhygienic Unfortunately, for many countries there is still schools are more likely to fall behind and drop a long way to go before the vision of a safe, out. UNICEF found that in low-income countries private toilet for every household will become only 46% of schools, on average, have toilets a reality. A pit latrine in poor repair in rural Niger. 4WaterAid Niger Part 1: The ten worst places in the world to find a toilet Part 1: The ten worst places in the world to find a toilet Bottom ranked: South Sudan Runners up: Niger, Togo, Madagascar Rank Country % of Gross Average life Maternal Child % of population national expectancy, mortality deaths, children without income at birth18 rate, sepsis- under stunted access to per capita (2013) related (per five, from (indicator of an ‘improved’ ($)(2014)17 100,000 diarrhoea malnutrition)21 toilet births)19 (per 1,000; (2015)16 2013)20 11 South Sudan 93.3 940 55 75.2 9.8 31 12 Niger 89.1 420 58 64.9 11.8 44 13 Togo 88.4 570 56 46.4 7.1 28 14 Madagascar 88.0 440 65 45.3 5.2 49 15 Chad 87.9 980 51 100.1 17.9 39 16 Sierra Leone 86.7 710 46 113.3 21.4 38 17 Ghana 85.1 1,600 61 39.1 6.0 19 18 Congo 85.0 2,710 59 42.2 2.5 25 19 Tanzania 84.4 930 61 42.2 3.8 35 10 Eritrea 84.3 680 63 39.1 5.1 50 Ibrahim Soumana, 15, a sixth- grader, in front of a WaterAid school latrine in the village of Sinder in the Tillaberi Region Ibrahimof Niger.